Mental Health Needs of Juvenile Offenders

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    Mental Health Needsof

    Juvenile Offenders

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    Mental Health Needs of Juvenile Offenders

    BySarah Hammond

    National Conerence o State Legislatures

    William T. Pound, Executive Director

    7700 East First PlaceDenver, Colorado 80230

    (303) 364-7700

    444 North Capitol Street, N.W., Suite 515Washington, D.C. 20001

    (202( 624-5400

    http://www.ncsl.org

    June 2007

    Cover design: Bruce Holdeman, 601 Design

    Printed on recycled paper2007 by the National Conerence o State Legislatures. All rights reserved.

    ISBN 1-58024-XXX-X

    This report is the frst in a planned series to ocus and provide research-based inormation on key policy

    issues in juvenile justice today. It is prepared under a partnership project o NCSLs Criminal Justice

    Program in Denver, Colo., and the John D. and Catherine T. MacArthur Foundation, headquartered

    in Chicago, Ill. The project is designed to highlight promising initiatives and state approaches and to

    inorm state legislative eorts in juvenile justice.

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    Prefaceand acknowledgmentsNCSLs publication department, or editing and

    coordinating art and production.

    The author grateully acknowledges Craig

    Wacker, program ocer, and Laurie Garduque,

    Ph.D., program director or Research, Human

    and Community Development or the John D.

    and Catherine T. MacArthur Foundation, or

    their support and assistance to NCSL and state

    legislatures.

    In addition to the author, Sarah Hammond,program

    principal in NCSLs Criminal Justice Program,

    other NCSL sta who contributed to this report

    and the project are Donna Lyons, group director

    or Criminal Justice, and Vicky R McPheron,

    sta coordinator. The author also thanks Donna

    Folkemer, group director or NCSLs Forum or

    State Health Policy Leadership, or comments

    and assistance; and Leann Stelzer, program

    principal, and Julie Lays, program principal, in

    contentsPreace and Acknowledgements ...................................... 3

    Introduction ................................................................... 4

    Disorders ........................................................................ 4

    Issues and Approaches .................................................... 5

    Conclusion ..................................................................... 9

    Notes ........................................................................... 10

    About the Author ......................................................... 11

    About the Funder ......................................................... 11

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    National Conerence o State Legislatures

    4 Mental Health Needs o Juvenile Oenders

    IntroductIon

    The prevalence o mental health problems among

    young people in juvenile justice systems requires

    responses to identiy and treat disorders. Many othe two million children and adolescents arrested

    each year in the United States have a mental health

    disorder. As many as 70 percent o youth in the

    system are aected with a mental disorder, and one

    in ve suer rom a mental illness so severe as to

    impair their ability to unction as a young person

    and grow into a responsible adult.1

    Children with unaddressed mental health needssometimes enter a juvenile justice system that is

    ill-equipped to assist them. Even i they receive a

    level o assistance, some are then released without

    access to ongoing, needed mental health treatment.

    An absence o treatment may contribute to a path

    o behavior that includes continued delinquency

    and, eventually, adult criminality. The Bureau o

    Justice Statistics estimates that more than three-

    quarters o mentally ill oenders in jail had prior

    oenses. 2 Eective assessment and comprehensive

    responses to court-involved juveniles with mental

    health needs can help break this cycle and produce

    healthier young people who are less likely to act out

    and commit crimes.

    dIsorders

    Youths may experience conduct, mood, anxiety

    and substance abuse disorders. Oten they have

    more than one disorder; the most common co-occurrence is substance abuse with another mental

    illness. Frequently, these disorders put children at

    risk or troublesome behavior and delinquent acts.

    Emotional disorders occur when a childs ability to

    unction is impaired by anxiety or depression. The

    Center or Mental Health Services estimates that

    one in every 33 children and one in eight adolescents

    are aected by depression, a potentially seriousmood disorder that also aficts many adults.3 The

    occurrence o depression among juvenile oenders

    is signicantly higher than among other young

    people.

    Anxiety disorders, in particular post-traumatic

    stress disorder, also are seen to be prevalent among

    juvenile oender populations, in particular, girls.

    Psychotic disorders such as schizophrenia, however,

    are rare in the general population as well as in justice

    system-involved youths.4

    Behavioral disorders are characterized by actions

    that disturb or harm others and that cause distress

    or disability. Attention Decit Hyperactivity

    Disorder (ADHD) and conduct disorder are

    typical youth behavioral disorders. ADHD, an

    increasingly common disorder among children,

    aects 3 percent to 5 percentor approximately

    2 millionAmerican children. Boys are aected

    two to three times more than girls, and the disorder

    oten continues into adolescence and adulthood.5

    The prevalence o disruptive behavior disorders

    among youths in juvenile justice systems is reported

    to be between 30 percent and 50 percent.6

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    National Conerence o State Legislatures

    5Mental Health Needs o Juvenile Oenders

    Substance abuse and dependency also are considered

    behavioral disorders and oten are linked to acts o

    crime and delinquency. In the Justice Departments

    Arrestees Drug Abuse Monitoring Program, juvenile

    male arrestees tested positive or at least one drug

    in at least hal the arrests in nine sites.7 Studies

    have shown that up to two-thirds o youths in

    the juvenile justice system with any mental health

    diagnosis had dual disorders, most oten including

    substance abuse.8

    Mental health disorders are more complicated and

    dicult to treat in youths than in adults. Because

    adolescence is a unique developmental period

    characterized by growth and change, disorders

    in youngsters are more subject to change and

    interruption.9 Ongoing assessment and treatment,

    thereore, are important.

    JuvenIle comPetency

    Mental health assessment o juvenile oenders helps to determine how the system can

    address their treatment needs. Another important purpose o mental health assessment

    is to address the legal issues surrounding a juveniles competency to understand the

    adjudicatory process and to thoughtully participate in and make decisions as part o that

    process.

    Typically, incompetence to stand trial is related to a mental disorder or developmental disability. Juvenile competency

    is urther complicated by developmental immaturity, with limited guidance in law on how to deal with this.31

    Developmental immaturity distinguishes many juveniles rom adults in important ways that make them less able to

    assist in their deense or to make important decisions as part o the process.32 This suggests that, in dening standards

    o competence or juveniles, simply applying the same standards as those used or adults will not work.33

    The U.S. Supreme Court decision in Kent v. United Statesgave juveniles many o the same due process rights aorded

    to adult deendants, including a right to counsel and, presumably, to be competent to stand trial.34

    At least 10 statesArizona, Colorado, Florida, Georgia, Kansas, Minnesota, Nebraska, Texas, Virginia and

    Wisconsinand the District o Columbia specically address competency in their juvenile delinquency statutes.

    Virginia statute, or example, directs how the issue o competency is to be raised and evaluated. 35 Charges against

    an unrestorably incompetent juvenile are to be dismissed in one year or a misdemeanor oense, and in three years

    rom the date the juvenile is arrested in what would be a elony case. 36 Competency-to-proceed law in Colorado

    similarly requires examination and stays proceedings against a juvenile who is ound incompetent.37

    Absent statutory direction, courts in other states also recognize and review juveniles or incompetence. In Arizona,

    case law supports a nding that, under state law, a juvenile need not have an underlying mental disease, deect or

    disability to be ound incompetent. In that case, a juvenile court ound that immaturity aected the ability o two

    juveniles to understand proceedings against them.38

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    National Conerence o State Legislatures

    6 Mental Health Needs o Juvenile Oenders

    Issuesand

    aPProaches

    Screening and Assessment

    Screening and assessment are key to addressing

    mental health treatment needs o youths in the

    juvenile justice system. Screening is a brie process

    that attempts to identiy those youngsters who

    warrant immediate mental health attention and

    require urther evaluation. Assessment builds on

    inormation gathered at screening, providing a

    more comprehensive and intensive examination

    o problems and behaviors exhibited by a young

    person.10 Proper assessment o juvenile oenders

    helps inorm those who determine risk, placement

    and treatment.

    According to the National Center or

    Mental Health and Juvenile Justice,

    youths who immediately receive a

    mental health screening are morelikely to have their problems identied

    and treated. Oten, however, screening

    and assessment take place only ater

    a juvenile has been adjudicated and

    placed in a correctional acility. A more

    prompt mental assessment o juveniles at

    initial court intake allows the inormation gained to

    be used in making diversion or other dispositional

    decisions.

    Eorts in Pennsylvania to improve the quality o

    services and care in juvenile justice have included

    the use o screening protocols to identiy young

    people with immediate needs as well as those who

    require urther assessment o noted mental health

    symptoms. All youths in Pennsylvania detention

    centers are screened using the Massachusetts

    Youth Screening Instrument, Version 2 (MSYSI-

    2). Screening has accomplished a more eective

    response to youths with mental health needs,

    including promoting awareness and competency

    among detention proessionals in the state.11

    The Cook County, Ill., Juvenile Court Clinic has

    an assessment process that is being adopted in other

    jurisdictions. The clinic consults with the court upon

    request, provides or orensic clinical assessments in

    response to court orders, and provides inormation

    about community-based mental health resources

    and education programs. A clinical coordinator

    present in the court room provides guidance to

    judges and probation sta about juvenile mental

    health evaluation and community-based treatment

    needs.12

    Other jurisdictions have created

    specialized courts to serve youth with

    mental health needs. The King

    County, Wash., Treatment Courtin Seattle, established in 2003, is

    a collaborative eort among the

    departments o mental health and

    substance abuse, the probation

    department and the juvenile court.

    Services are ocused on youths with psychiatric

    disorders and substance abuse or dependence, with

    a moderate to high risk o re-oending. Screening,

    ollowed by more thorough evaluation o juveniles

    who present treatment needs, identies those who

    may be suitable or services such as multi-systemic

    therapy, which includes individual and amily

    therapy and substance abuse interventions.13

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    National Conerence o State Legislatures

    8 Mental Health Needs o Juvenile Oenders

    Diversion programs being used in communities

    throughout the country include models identied

    by the National Center or Mental Health and

    Juvenile Justice. The Integrated Co-Occurring

    Treatment Model in Akron, Ohio, is an intervention

    program that serves youths in the justice system

    who exhibit mental health problems and substance

    abuse. The program provides diversion services

    or youths reerred by the court and also oers a

    reintegration program. Juveniles go through an

    extensive assessment, ollowed by individual and

    amily therapy interventions.22

    Omnibus mental health legislation passed in

    Washington in 2005 expanded mental health

    services in the state and addressed treatment

    gaps. It also encouraged diversion and treatment

    in criminal and juvenile justice by authorizing

    counties to establish a 0.1 cent sales tax to establish

    therapeutic courts. Under the law, human services

    and corrections agencies are required to work

    together to help people with mental disorders ater

    they are released rom connement.23

    Access to mental health services upon release is an

    important part o a comprehensive approach to

    addressing mental health needs o juvenile oenders.

    Without ongoing treatment, many children are

    more vulnerable to behaviors that prompt their

    return to the system. Community-based and home-

    based mental health services, amily-based therapy,

    youth mentoring, and recreational and social

    opportunities are among programming options that

    help create a continuum o care or young people.

    Recent legislation in Virginia requires the Board

    o Juvenile Justice to develop regulations or the

    planning and provision o mental health, substance

    abuse or other therapeutic treatment services or

    young people who are returning to the community

    ollowing commitment to a juvenile correctional

    center or post-dispositional detention.24 Such

    actions provide an important policy ramework or

    the mental health needs o juveniles.

    Collaboration

    Mental health disorders in youth are complex

    community problems. Juvenile justice systems

    benet rom the expertise o community health

    providers in dealing with disordered kids. In

    a growing number o jurisdictions across the

    country, juvenile justice and mental health systems

    are working in concert to identiy and respondto the mental health needs o juveniles. Eective

    arrangements require that each agency understand

    and respect the others purposes and missions. Done

    well, collaboration between the juvenile justice

    system and mental health agencies can provide

    appropriate and eective services and treatment to

    juveniles.

    WrapAround Milwaukee, recognized as a model or

    collaboration, has successully integrated mental

    health, juvenile justice, child welare and education

    systems to provide services to youths. The program

    serves adjudicated delinquents and sustains itsel

    by pooling unds with its system partners. The

    integrated, multi-service approach to meeting the

    needs o juveniles includes a ocus on the amilys

    strengths and culture, as well as those o the

    neighborhood or community. Treatment plans are

    tailored to address the unique needs o each child

    andamily. Evaluations indicate that the program

    is achieving positive results.25 The use o residential

    treatment has decreased by 60 percent since the

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    National Conerence o State Legislatures

    9Mental Health Needs o Juvenile Oenders

    programs inception, and inpatient psychiatric

    hospitalization decreased 80 percent. The average

    overall cost o care per child declined rom $5,000

    per month to less than $3,300 per month.26

    Similarly, the Dawn Project in Indiana has

    successully approached juvenile mental health needs

    with a collaboration among the Family and Social

    Services Administration; the divisions o Mental

    Health and Addiction; the Indiana Department o

    Education; the Indiana Department o Corrections;

    the Marion County Oce o Family and Children;

    the Marion Superior Court, including the Juvenile

    Division; and the Mental Health Association.

    The program helps youths with serious emotional

    disturbances and their amilies by developing

    integrated care plans designed to address each

    amilys unique situation.

    Legislation in several states

    has specically addressed

    collaboration. Caliornia

    requires the Department

    o Youth Authorityand the Department

    o Mental Health to collaborate on

    training, treatment and medication guidelines

    or youths with mental illness who are under the

    jurisdiction o the Department o Youth Authority.27

    Colorado law instructs the Department o Human

    Services to select one urban and one rural site

    or community-based, intensive treatment and

    supervision pilot programs or mentally ill juveniles

    who are involved in the criminal justice system.

    The law requires juvenile justice and mental health

    agencies to collaborate in this eort.28 In 2004,

    Colorado also created legislative oversight and a 29-

    member task orce or the continuing examination

    o the treatment o people with mental illness in the

    justice system.29

    West Virginia law also encourages collaboration,

    allowing the Division o Juvenile Services to convene

    multidisciplinary treatment teams or juveniles

    in their custody. As appropriate, team members

    include a juvenile probation ocer, social worker,

    parents or guardians, attorneys, appropriate school

    ocials, and child advocacy representatives.30

    conclusIon

    The mental health and substance abuse needs o

    court-involved youths challenge juvenile justice

    systems to respond with eective evaluation

    and intervention. Active partnerships with the

    mental health community and other child-serving

    organizations can improve the care and treatment

    o these young people and prompt healthier results

    or individuals, amilies and communities.

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    National Conerence o State Legislatures

    10 Mental Health Needs o Juvenile Oenders

    Notes

    1. Kathleen R. Skowyra and Joseph J. Cocozza,Blueprint or Change: A Comprehensive Model or theIdentifcation and Treatment o Youth with MentalHealth Needs in Contact with the Juvenile Justice System

    National Center or Mental Health and Juvenile Justice(Washington, D.C.: National Center or Mental Healthand Juvenile Justice, Drat January 2006), ix.

    2. Paula M. Ditton,Mental Health Treatment oInmate and Probationers (Washington, D.C.: Bureau o

    Justice Statistics, July 1999), 1.3. The Center or Mental Health Services,. http://

    mentalhealth.samhsa.gov/cmhs/4. Ibid.5. National Institute o Mental Health, U.S.

    Department o Health and Human Services,AttentionDefcit Hyperactivity Disorder(Washington, D.C.:

    NIMH, 2006), 2.6. National Mental Health Association, Prevalenceo Mental Disorders Among Children in the JuvenileJusticeSystem (Alexandria, Va.: NMHA, 2006), 2.

    7. National Institute o Justice,2000 AnnualReport on Drug Use Among Adult and Juvenile Arrestees,Arrestees Drug Abuse Monitoring Program (ADAM)(Washington, D.C.: NIJ, April 2003), 133-134.

    8. National Mental Health Association, Prevalenceo Mental Disorders Among Children in the JuvenileJustice System, 2.

    9. Thomas Grisso, Double Jeopardy: AdolescentOenders with Mental Disorders (Chicago: University o

    Chicago Press, 2004).10. Thomas Grisso, G. Vincent, and D. Seagrave,

    Mental Health Screening and Assessment in JuvenileJustice(New York: Guilord, 2005).

    11. Thomas Grisso and V. Williams, WhatDo We Know About the Mental Health Needs oPennsylvanias Youth in Juvenile Detention? Findings andRecommendations rom the Mental Health Assessment oYouth in Detention Project(Harrisburg, Pa.:JuvenileDetention Centers Association o Pennsylvania, July2006).

    12. Kathleen R. Skowyra and Joseph J. Cocozza,Blueprint or Change: A Comprehensive Model or the

    Identifcation and Treatment o Youth with Mental HealthNeeds in Contact with the Juvenile Justice System NationalCenter or Mental Health and Juvenile Justice, 55.

    13. Ibid., 56.14. Idaho Code 20-211A15. Nev. Rev. Stat. Ann. 6216. Texas Human Resources Code, Title 10,

    Section 141.042(e).17. Minnesota Statute, Chap. 260B, 157.

    18. Albert R. Roberts and Kimberly Bender,Overcoming Sisyphus: Eective Prediction o MentalHealth Disorders and Recidivism among Delinquents,Federal Probation (Administrative Oce o the U.S.Courts, Washington, D.C.) 70, no. 2 (September2006), 1-4.

    19. Kathleen R. Skowyra and Joseph J. Cocozza,Blueprint or Change: A Comprehensive Model or theIdentifcation and Treatment o Youth with Mental HealthNeeds in Contact with the Juvenile Justice System NationalCenter or Mental Health and Juvenile Justice, 25.

    20. Kathleen Skowyra and Susan DavidsonPowell, MA, Juvenile Diversion: Programs orJustice-Involved Youth with Mental Health Disorders(Washington D.C.: National Center or Mental Healthand Juvenile Justice, June 2006), 1.

    21. Ibid, 3.22. Ibid, 4.23. Rev. Code Wash. 71

    24. Va. Code Ann. 16.1-293.125. Bruce Karmradt, Wraparound Milwaukee:

    Serving Youth With Mental Health Needs, http://www.ncjrs.gov/html/ojjdp/jjjnl_2000_4/wrap.html, April, 2000

    26. Ibid.27. Caliornia Welare Institutions Code, 1077,

    1078 and 1755 (2000).28. Colorado Revised Statutes, 16-8-201

    through 205(2000).29. Colorado Revised Statutes, 18-1.9-101

    through 106 (2004).30. W. Va. Code 49-5-13a; 49-520; 49-5D-331. Thomas Grisso,Juvenile Competency to Stand

    Trial: Questions in an Era o Punitive Reorm (Chicago:American Bar Association, Criminal Justice Magazine,Fall 1997), 1.

    32. Thomas Grisso et al. Juveniles competenceto stand trial: A comparison o adolescents andadults capacities as trial deendants, Law and HumanBehavior27, no. 4 (2003): 333-363.

    33. Thomas Grisso, Clinical Evaluations orJuveniles Competency to Stand Trial: A Guide or LegalProessionals(Sarasota, Florida: Proessional ResourcePress, 2005), 5-7.

    34. Kent v. United States, 383 U.S. 541 (1966).35. Va. Code 16.1-356.36. Va. Code 16.1.358.37. Colo. Rev. Stat. 19-2-1302 1304.38. In re Hyrum H, 131 P.3d 1058 (ct.App.2006)

    and Ariz. Rev. Stat. Ann 8-291 - 291.11.

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    National Conerence o State Legislatures

    11Mental Health Needs o Juvenile Oenders

    aboutthe author

    Sarah Hammond is a program principal in NCSLs Criminal Justice Program. She is the lead sta person on

    NCSLs Inorming Juvenile Justice Policy Project with the John D. and Catherine T. Mac Arthur Foundation.

    She is the author o several publications related to juvenile justice and victims issues and is also a contributor toNCSLs State LegislaturesMagazine. Beore joining NCSL, she worked in Washington, D.C., or ve years as a

    legislative assistant to a U.S. Senator. She has been admitted to the Colorado Bar.

    aboutthe funder

    The John D. and Catherine T. MacArthur Foundation is a private, independent grantmaking institution

    dedicated to helping groups and individuals oster lasting improvement in the human condition. Its juvenile

    justice initiative supports research, model programs, policy analysis and public education to promote more

    eective juvenile justice systems across the country. A new eort, Models or Change, seeks to accelerate

    system-wide change in Illinois, Louisiana, Pennsylvania and Washington, with the hope that the results will

    serve as models or successul reorm in juvenile justice systems in other states. For more inormation or to sign

    up or MacArthurs monthly electronic newsletter, visit www.macound.org.

    The MacArthur Foundation supports a Research Network on Adolescent Development and Juvenile Justice

    at Temple University in Philadelphia, Penn. The network is building a oundation o sound science and legal

    scholarship to help inorm the next generation o reorm o juvenile justice systems. More inormation, including

    issue bries on important adolescent development topics, is available at www.adjj.org.

    Mental Health Needs o Juvenile Oendersis part o a series o NCSL Criminal Justice Program brieng papers

    to ocus on and provide research-based inormation about key issues in juvenile justice today. For more

    inormation, see http://www.ncsl.org/programs/cj/juvenilejustice.htm.

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    The National Conerence o State Legislatures is the bipartisan organization that serves the legislators andstas o the states, commonwealths and territories.

    NCSL provides research, technical assistance and opportunities or policymakers to exchange ideas on themost pressing state issues and is an eective and respected advocate or the interests o the states in theAmerican ederal system.

    NCSL has three objectives:

    To improve the quality and eectiveness o state legislatures.To promote policy innovation and communication among state legislatures.To ensure state legislatures a strong, cohesive voice in the ederal system.